The Department of Radiation Oncology at Cleveland Clinic treats more patients than any other cancer center in Ohio and is nationally recognized as a leader in patient care, research and education.
Ranked No. 7 in the country and best in Ohio by US News and World Report, our radiation oncologists and entire cancer care team at the Cleveland Clinic Cancer Center provide:
- High-quality, experienced, compassionate multidisciplinary care
- Personalized treatment plans that consider our patient’s health, age, cancer type and ability to tolerate potential side effects
- Leading-edge technology that delivers radiation with maximum precision, reducing treatment time
- Nine convenient locations throughout Northern Ohio
- Treatment options for the full range of cancer types
- Access to more than 200 innovative clinical trials
Meet Our Team
Along with radiation oncologists, our department is comprised of several other team members that directly or indirectly assist our patients throughout his or her cancer treatment.
Throughout your radiation therapy treatments you will work with Nurse Practitioners (NPs). NPs play an active role in your treatment in collaborating with your staff physician to perform physical exams, review treatment and follow laboratory and radiology results on a daily basis. They are a constant member of the radiation oncology team, providing consistent care to you and your caregivers with an additional focus on quality of life and symptom management.
- Molly Freeman, MSN, ANP-BC
- Bridgett Harr, MSN, NP-C OCN
- Sherry Soeder, MSN, CNP, AOCNP, ACHPN
- Richard Thousand MSN, CNP, RN
Cleveland Clinic's medical dosimetrists have the education and expertise necessary to generate radiation dose distribution and dose calculations in collaboration with medical physicists and radiation oncologists. Our medical dosimetrists can design a treatment plan by means of a computer to deliver a prescribed radiation dose. When designing a plan, the dosimetrist takes into consideration the dose-limiting normal structures, such as the lens of the eye, the spinal cord, or the heart.
Our certified dosimetrists are members of Cleveland Clinic's nationally recognized Department of Radiation Oncology and can provide remote dosimetry planning to meet short- and long-term staffing needs of cancer centers across the nation. Image and data transfers are made via a secured FTP portal between your institution and Cleveland Clinic.
Radiation Oncology coordinators are administrative support representatives who assist in maintaining a variety of clinical programs, events and activities in the department of Radiation Oncology. Along with establishing schedules for events the coordinator represents programs effectively and professionally. The coordinators work collaboratively with both internal and external clientele.
Administrative Assistants perform a variety of administrative and clerical duties to support the physician staff in Radiation Oncology. These duties include: answering phone calls, handling and preparing correspondence, and keeping accurate and up-to-date schedules for the physicians. They must be well organized in order to maximize the efficiency of their physician's time.
Delivering compassionate care to patients and their families is the primary focus of the nurses in the Department of Radiation Oncology at Cleveland Clinic.
We strive to provide excellent nursing care to:
- Maximize health
- Enhance quality of life
- Relieve suffering
- Provide education and support to patients and their families
Promoting an environment that respects diversity, enhances quality of life and preserves human dignity, radiation oncology nurses collaborate with other professionals involved in patient care, including doctors, nurse practitioners, dietitians and social workers.
Patient Service Representatives
Patient Service Representatives provide our Radiation Oncology patients with excellent customer support. This group of trained individuals work with the patients to schedule a variety of complex appointments over the duration of their treatment. Additionally, they check patients in for treatments, offer support and provide information concerning financial clearance. Dedicated to patient satisfaction, our Patient Service Representatives strive for excellence to meet the needs of our diverse patient population.
The radiation therapist is an integral part of the cancer treatment team. The therapist administers and records targeted doses of prescribed radiation. The radiation therapists are compassionate professionals educated in physics, radiation safety, human anatomy and patient care.
The Radiation Oncology research team has the responsibility of oversight of numerous clinical research trials. These trials include therapeutic, retrospective, chart review, and database studies. The research team is comprised of the biostatistician, a data coordinator, regulatory coordinators, a research nurse, and a research supervisor. Our current Radiation Oncology clinical research trials are available online.
Special Procedure Group
The special procedures team consists of Radiation Therapists that have advanced training in the delivery of internal radiation therapy. Procedures include: intracavitary implants, interstitial impants, ocular implants, hyperthermia, and brachytherapy for treatment of the prostate.
What We Treat
This is a treatment that uses high-energy rays (such as X-rays) to kill cancer cells. It is usually delivered from the outside of the body (external beam radiotherapy), and it is routinely performed as an outpatient treatment. External beam radiotherapy is usually given daily (each session lasting for approximately 20-25 minutes) daily for up to five to seven weeks.
External beam radiotherapy can also be given with weekly chemotherapy (low-dose) with the goal of enhancing the killing effects of the radiation. For selected patients with bladder cancer, radiation therapy can be used instead of surgery; however, it's much less effective than surgery. You need to discuss with your physician whether you are a candidate for external beam radiotherapy and its potential side effects.
The Department of Radiation Oncology is one of the few departments in the region to offer true three-dimensional treatment planning capabilities. This advanced computer-based planning system uses CT and /or MRI images to help define optimal distribution of radiation dose within critical normal tissues like the brain. A major goal of the brain tumor radiotherapy program is to develop a system that can "fuse" all available diagnostic imaging information thereby establishing the most precise definition of the areas to be included in the treated volume. This process will allow the design of more specific radiation dose deposition strategies, thereby decreasing the risk of late neuropsychiatric complications and brain necrosis.
Within the actual target area, several recent clinical studies have clarified the radiation dose requirements necessary for long term brain tumor control. Based on these studies, it appears that many tumor types (especially high-grade gliomas) will require significantly higher central target doses than conventional radiotherapy techniques allow. One method of providing this sort of localized dose escalation involves a computer-assisted stereotactic brain "implant" using high activity Iodine-125. Cleveland Clinic is currently investigating a number of these newer stereotactic radiotherapy implant approaches in an attempt to define optimal methods of boosting sites of residual brain tumor after conventional external beam irradiation.
Cleveland Clinic's Stereotactic Radiosurgery ("Gamma Knife") program was the first operational radiosurgery unit in Ohio. In this approach, a conventional linear accelerator is retrofitted with a number of special targeting and patient immobilization aids to allow high-precision (in some cases, sub-millimeter) focus of radiation beams generated via a series of converging treatment arcs. This approach is especially useful in the treatment of single or multiple brain metastases. For patients with metastases measuring less than 3 cubic centimeters, up to 90% long-term control rates are expected after a single treatment. Thus, radiosurgery offers a convenient, highly effective alternative to inpatient surgical procedures for brain metastases.
The use of radiosurgery in the treatment of many types of primary brain tumors and various "functional" diseases (such as trigeminal neuralgia) is also being investigated at the Clinic.
Breast Cancer is one of the true specialties of the Department of Radiation Oncology, and several hundred breast cancer patients are treated each year. The central focus of our breast radiotherapy programs for breast cancer involve the development of beam alignment and shielding techniques that minimize radiation dose to nearby lung and heart tissue that is received during breast radiation therapy. Specialized breast radiotherapy treatment protocols and computer software allow optimized patient set-up and radiation beam alignment. All breast radiotherapy patients undergo computerized treatment planning to allow minimization of radiation "hot spots" and "cold spots," thus decreasing the risk of radiation complications and tumor recurrence in the irregularly contoured breast tissue.
Cleveland Clinic Department of Radiation Oncology maintains one of the most active radiation implant ("brachytherapy") programs in the country, and gynecologic malignancies represent a major clinical focus for this program. Over one hundred brachytherapy applications are performed each year for gynecologic tumors of various stages. Members of Radiation Oncology's clinical staff have special expertise in gynecologic oncology using brachytherapy, and are fully board-certified in both gynecology and in radiation therapy.
Cleveland Clinic is one of the few departments in the region to offer mechanized high dose-rate ("HDR") brachytherapy. This brachytherapy system involves a computer-assisted gear-driven piston assembly that can march a high-activity radioactive source through a series of carefully planned treatment positions via catheters implanted within and around a tumor target. This automated sequence is performed under physician and physicist guidance in the specially shielded suite within the department. This suite is currently being outfitted for intra-operative HDR brachytherapy, adding an additional dimension to the department's brachytherapy programs in this area.
A full range of megavoltage external beam treatment machines and conventional low dose-rate brachytherapy equipment completes the therapeutic armamentarium used by the Gynecologic Oncology section of the department.
Head & Neck
Cancers of the head and neck are highly treatable using radiation therapy. For early stage tumors of many sites, radiotherapy offers an equally efficacious and generally less toxic alternative to radical surgery. For more advanced tumors, pre-operative or post-operative radiotherapy is often combined with conservative surgery by our cancer specialists to allow effective tumor control without severely disfiguring or dysfunctional treatment consequences.
Cleveland Clinic is currently investigating the use of combined chemo-radiotherapy for many upper aerodigestive tract tumors. This multimodality approach taken by our cancer specialists may allow organ preservation even in cases where critical structures near the larynx are densely invaded by the tumor. Close clinical coordination among the specialists--the medical oncologist, the radiation oncologist, and the surgeon--is essential to the successful implementation of this program. Direct extramural referrals from Cleveland area medical oncologists and ENT surgeons are welcome.
Our department of Radiation Oncology and our cancer specialists are constantly evaluating the clinical outcomes of its treatment programs in order to optimize patient care. The departmental data for the control of early stage vocal cord cancers was recently presented at a professional meeting, and the data confirmed a 3-year local control rate of over 90% for the entire group. For those patients with highly localized tumors, the control rate was 100%. Additionally, the highly individualized treatment plans employed by our cancer specialists for these lateralized tumors result in significantly less soft-tissue edema and skin necrosis compared with patients treated using other radiotherapy techniques.
Advanced technologies are now available for optimizing management, such as the incorporation of IMRT and other means of limiting side-effects of treatment and increasing cure rates.
Radiotherapy is an integral, foundational component in managing lung cancer. The role of lung radiotherapy for an individual patient, whether for potential cure or symptom relief in advanced disease, is determined after consultation with a Cleveland Clinic Radiation Oncologist. This consultation often is in the context of a multidisciplinary thoracic oncology lung cancer review involving other pulmonary specialties, including medical and surgical thoracic oncologists and Pulmonary Medicine.
The Radiation Oncology Lung Program also actively offers patients an opportunity to participate in appropriate lung radiotherapy clinical trials and is the leading service within the Department of Radiation Oncology in that regard. For each lung cancer patient, the approach is to offer optimal, individual medical care in the context of high-level, technological expertise, including lung radiotherapy. Computerized tomography (CT-scan)-based, three-dimensional treatment planning; intensity modulated radiotherapy (IMRT); and stereotactic body radiotherapy are among the options available at Cleveland Clinic. With these approaches, individualized treatment plans can be developed with the goals of minimizing the amount of normal body tissue receiving high-dose radiotherapy while maximizing cancer destruction.
Refractory or metastatic lung tumors pose a serious oncological problem, with many patients suffering from airway obstruction, bleeding, and pain syndromes. These syndromes often are in the context of previous treatments, and, therefore, there are few options. For these patients, the Department of Radiation Oncology has developed a series of novel palliative techniques aimed at relieving obstruction and reducing mass effects from these tumors. Bronchoscopically directed, high-dose-rate (HDR), endobronchial brachytherapy can be quite effective in relieving local obstructive symptoms. Stereotactic body radiotherapy may be appropriate for retreatment in the chest or for dealing with complex metastatic cases. Same-day consultations with expedited treatment schedules are available for urgent cases.
Doctors also use lung radiotherapy, often combined with chemotherapy, as primary treatment instead of surgery. Lung radiotherapy may also be used to relieve symptoms such as shortness of breath. Radiation for the treatment of lung cancer most often comes from a machine (external radiation). The radiation can also come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation or brachytherapy)
Lung radiotherapy affects normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the part of the body that is treated and the treatment dose. Common side effects of lung radiotherapy are a dry, sore throat; difficulty swallowing; fatigue; skin changes at the site of treatment; and loss of appetite. Patients receiving radiation to the brain may have headaches, skin changes, fatigue, nausea and vomiting, hair loss, or problems with memory and thought processes.
Lung radiosurgery is a form of delivering higher dose of radiation to a small tumor. It could be used sometimes to replace surgery especially in those patients who may not be suitable for surgery.
Lymphocyte-derived neoplasms have long been considered highly sensitive to the effects of ionizing radiation and our department of Radiation Oncology is very experienced in the implementation of exacting technical set-ups such as "Mantle" radiotherapy fields and "Total Nodal Irradiation" plans for selected malignant lymphoma patients.
Cleveland Clinic Radiation Oncology is deeply involved in the investigation of both conventional radiotherapy and specialized new technologies that may be applicable to the treatment of malignant lymphomas. Conventional external beam radiotherapy has long been a mainstay in the treatment of both Hodgkin's and non-Hodgkin's lymphoma. For Hodgkin's disease, selected early-stage cases may be treated with definitive radiotherapy, yielding long-term survival rates in excess of 90%. The combination of chemotherapy and lower dose "involved field" radiotherapy also provide excellent long-term survival and can often limit the toxicity of treatment compared to radiotherapy alone. This combination of chemotherapy and local field radiotherapy also plays a major role in more advanced stage cases of Hodgkin's disease.
In a similar way, many cases of Non-Hodgkin's Lymphoma (NHL) show substantial improvements in the relapse-free survival when local field radiotherapy is added to systemic radiotherapy treatment, such as chemotherapy or immunotherapy. Data from several large randomized multicenter trials show that intermediate doses of radiation (30 - 45 Gy) can provide long term NHL control when accompanied by intermediate dose chemotherapy. In some cases of indolent NHL, the use of radio-immunotherapy allows the combination of specifically targeted radiopharmaceutical therapy and antibody-based immunologic targeting to optimize tumor control with minimal toxicity.
When we combine chemotherapy with radiotherapy, we usually start with chemotherapy and reserve radiotherapy for the point at which chemotherapy has demonstrated its maximal response. Side effects and total numbers of chemotherapy and radiotherapy treatments will depend on the type of lymphoma, the area under treatment, and the specifics of the patient's medical history. The radiation oncologists at the Cleveland Clinic who specialize in lymphoma are accustomed to working closely with medical oncologists both at the Cleveland Clinic and elsewhere in the medical community. This "team approach" assures a seamless collaboration between the medical disciplines.
Ocular melanoma is a rare tumor of the eye which requires special expertise and interdisciplinary cooperation to treat if vision is to be preserved. This treatment often includes radiotherapy. Cleveland Clinic participates in national protocols sponsored by the Collaborative Ocular Melanoma Study. Radiotherapy treatments are frequently delivered in the form of custom-made radioactive plaques temporarily positioned behind the eye to aid in the delivery of radiotherapy. Plaques are formed using radioactive seeds on a gold shield shaped to the eye. The gold base effectively prevents irradiation and prevents the radiotherapy from reaching deeper structures such as the brain.
The care of the pediatric cancer patient requires special clinical coordination and interpersonal skills, and often requires a radiotherapy or brachytherapy treatment program. The Department of Radiation Oncology is well equipped to handle all such cases of pediatric cancer, including those requiring daily anesthesia during the period of treatment. Cleveland Clinic has a rapidly expanding pediatric practice, and the ongoing expansion and renovations taking place within the Cleveland Clinic Children's division ensure that a full range of ancillary pediatric specialists and pediatric cancer support programs are available to supplement the brachytherapy and radiotherapy treatments.
After a diagnosis of prostate cancer has been established with a biopsy, the patient should discuss the treatment options, like prostate brachytherapy or prostate seed implants, with their health care provider.
Some unique features of our program include:
- The first group to publish the improvements gained by treating patients with one session in which the treatment planning and treatment occurs on the same day. This also results in greater convenience for the patient since one less visit is necessary.
- The first prostate brachytherapy program in the country to use the Memokath prostate stent to help reduce side effects after prostate brachytherapy.
- The lowest rectal side effect profile of any published series. Our rectal bleeding rate is 1% and we have not had any rectal perforations or fistulas.
- Download a Treatment Guide
Sarcoma radiation therapy (sometimes in conjunction with chemotherapy) may be given before surgery to shrink the tumor and allow complete resection. After surgery, additional (adjuvant) sarcoma radiation therapy is sometimes used to kill any cancer cells that remained after surgery and to reduce the chances of the tumor returning in the area of its origin.
Sarcoma radiation therapy is a form of cancer treatment that uses x-rays or other high-energy rays to kill cancer cells.
There are two ways of delivering radiation to the cancer:
- External Radiation: External beam radiation therapy (EBRT) is the most common form of radiation therapy. The treatment machine (linear accelerator) directs beams of high-energy radiation at the tumor. The machine can change position so that the beams can enter the body from any angle. External radiation therapy is usually given in daily treatments of few minutes each over several weeks, typically 5 days a week for 5 to 6 weeks.
- Internal Radiation: Internal sarcoma radiation therapy (brachytherapy) delivers a high dose of radiation to a small area by using one or more implants (radioactive sources) placed in or around the tumor. These implants can be temporary or permanent.
The radiation oncologist will select the type of therapy that is most suitable for a particular type of cancer. Radiation therapy can also be used to palliate (ease) symptoms of sarcoma when it has spread to other body organs.
The medical oncologist will select the type of therapy treatment that is most suitable for a particular type of cancer.
Radiotherapy has traditionally played an important role in the treatment of a wide range of benign and malignant skin tumors. Both electron beam therapy and a modern orthovoltage treatment machine with a penetration depth that is optimized for dermatologic lesions are available at Cleveland Clinic. For small squamous cell or basal cell carcinomas, often just a few high-dose radiotherapy treatments to small target areas will suffice to cure the lesion. Conversely, the department is also experienced in the design of very complex clinical treatment plans, such as total skin electron therapy for patients with mycosis fungoides.
Active Breathing Coordinator is a non-invasive device that under the patient's control pauses breathing during radiation treatment to halt internal motion – therefore allowing greater conformity of the radiation beam to the tumor.
Brachytherapy is a type of radiation therapy involving the placement of radiation sources near the tumor or within a body cavity.
Clarity Breast System
Patients undergoing radiation treatment for breast cancer benefit from more accurate targeting of the treatment area without added risk with the Clarity Breast System.
Cleveland Clinic uses Edge radiosurgery systems with state-of-the-art technology that integrates treatment planning in one system. Edge radiosurgery accurately shapes the radiation beam to the area to be treated and uses imaging guidance and other methods to target the tissue or tumor to be treated while avoiding surrounding healthy tissues.
Hyperthermia therapy is a non-invasive method of increasing tumor temperature to stimulate blood flow, increase oxygenation, augment the anti-tumor immune response and render cancer stem cells more sensitive to radiation.
Image guided radiation therapy (IGRT) involves the use of imaging technology such as X-ray, ultrasound, or optical imaging to direct the delivery of radiation during radiation therapy treatment.
Intensity Modulated Radiation Therapy (IMRT) is the practice of delivering multiple beams of radiation to separate tumor sites in order to more effectively treat large tumor areas.
The Intrabeam Intraoperative Radiation Therapy (IORT) device delivers low energy, high dose radiation directly to the tumor bed in the operating room.
Intravascular Brachytherapy (IVBT)
Intravascular Brachytherapy (IVBT) temporarily places radioactive sources in the blood vessel that has been recently opened after having been blocked by scar tissue or “restenosis”.
The radiation from the IVBT treatment helps prevent the vessel from blocking with more scar tissue. The procedure is performed in the Cardiac Catherization Lab
Positioning women with early stage and ductal breast cancer in prone (face down) position while undergoing radiation treatments substantially limits the radiation dose that reaches the heart, lung, and skin.
A radioactive plaque is a sealed device that delivers a high dose of radiation to a tumor. The plaque is positioned on the surface of the eyeball directly over the tumor inside the eye.
Radiolabeled Antibody Therapy is the use of "targeted radiotherapy" that can be injected into the circulation and allowed to localize simultaneously in many different sites of disease involvement.
After 20 years of experience and expertise, Cleveland Clinic continues to offer patients the most technologically advanced stereotactic radiosurgery available.
TheraSphere is a type of brachytherapy used for inoperable hepatocellular or liver carcinoma. TheraSphere consists of millions of radioactive microscopic glass spheres, which are infused into the arteries that feed liver tumors.
Total Body Irradiation is often given in the context of a bone marrow transplant, and in the past it has generally involved very high doses of radiation given over a period of days just prior to the infusion of the transplanted bone marrow or blood stem cells.
Clinical Trials & Research
Cleveland Clinic Cancer Center clinical trials offer patients important treatment options and access to the latest treatments and procedures resulting from cancer research.
Cleveland Clinic Cancer Center is committed to working with you to provide the best care for your patients. Our team is also dedicated to the training and education of medical professionals to advance cancer care and research.
If you need assistance with your dosimetry planning, Cleveland Clinic's eDosimetry services can help. Medical Dosimetrists design an individualized plan of treatment for cancer patients who have been prescribed radiation therapy by their oncologist. They use computer sciences and mathematics to calculate an appropriate dosage and position for the treatment and communicate with the patient's oncologist to have the plan of treatment approved.
Radiation Oncology Educational Programs
Cleveland Clinic's Radiation Oncology Postgraduate Educational Program is among the most highly regarded in the United States. A critical factor in its success is its full integration within Cleveland Clinic's Taussig Cancer Institute, which is recognized by U.S. News & World Report as one of the top cancer center in the country. Cleveland Clinic offers extensive clinical experience to its residents and fellows, all within the setting of an urban tertiary cancer center.